Altered states: pills alone won't cure the blues

Commonweal, May 21, 2004 by Gordon Marino

Not long ago I bumped into one of my student advisees. I hadn't seen him for a couple of months and I asked him how he was faring. A warm and congenial young man, he smiled broadly but then his shoulders slumped as he confessed, "I have just been diagnosed with ADD." The way he said it you would have thought that they had found a virus or bacterium in his brain. "Who isn't ADD?" I jokingly consoled him. "What's the treatment plan?" The young man responded by jumping up and down so that I could hear the chimes of pills rattling in his backpack. He was not worried that I would think he was daft, because he knew that these days virtually all are going into the medicine cabinet to find themselves. Indeed, in an ethics course I taught a couple of years ago at another college, I stumbled onto the topic of medication in our final session and found that two-thirds of the students had been or were on regimens of psychotropic drugs.

The ease with which we now resort to chemical solutions for psychological problems is nothing short of alarming. According to the latest figures, an astounding one in eight Americans is now taking antidepressants. Captains of the mental-health industry believe that depression is still underdiagnosed and that with just a little more public education, every fifth adult American will soon be groping for peace of mind in a prescription. For all the old rhetoric about wars on drugs there seems to be no limit to our appetite for pharmaceutical solutions to problems in living.

In a preface to the second edition of his The Mind's Fate: A Psychiatrist Looks at His Profession (published in 1995), Robert Coles observed, "These days, more and more, psychiatrists think of their patients as neurochemically unbalanced in one way or another, as challenges, therefore, to a gradual process of drug initiation and titration. A growing number of patients spend little or no time talking with their doctors about their everyday difficulties in getting through life; rather they hope for a kind of calm to settle on them courtesy of a pill that will do its work, cast its magic spell by dint of its effects on the brain's circuitry." Coles offered this assessment almost ten years ago and the winds have by no means shifted--they are only gusting stronger.

Coles noted that many young physicians were healing themselves with the same balms they prescribed for patients. A novice psychiatrist on antidepressants told Coles, "I feel good now where I used to feel crummy all the time." When asked what he thought was making him feel crummy, the young doctor drew a blank. Coles observed, "I wonder at this point why I am so concerned. Perhaps I have the old-fashioned sense that this young man in fact had good reason to feel some anxiety, some moments of sadness." The doctor's brother was dying and he was on the brink of some major life decisions. In other words, for Coles, the crummy feeling the young man was trying to short circuit was the intellect at work trying to understand loss and the anxiety of decision making. Of course, when such feelings completely unhinge us, medication is appropriate; however, short of becoming unhinged, there is good reason to believe both that our emotions have something to tell us and that the way we respond to our emotions is a significant part of the curriculum of our lives.

Last year, a student approached me at the end of the semester to ask for an extension on her final paper. She told me that she was "clinically depressed." I asked, "Did something happen?" But the young woman assured me, "It's nothing but a chemical imbalance." A few minutes later she told me that her parents had recently announced they were getting divorced, but she quickly added that she was certain their break-up had nothing to do with her blues.

Although he approached this problem from Christian presuppositions, theologian H. Richard Niebuhr did not think that one needed faith to grasp that "in the life of the self, responding to action upon it in the present ... does not come through the rejection of the past but through its reinterpretation." According to Niebuhr, just as a nation must come to understand its history so must the individual reckon with his or her past. Some of the psychic pangs that we are encouraged to cast pills at today are the invitation to that seminar with ourselves. And yet modern psychiatry increasingly proceeds as if we could become ourselves without any serious study of the pages of our own past.

In Beyond Therapy: Biotechnology and the Pursuit of Happiness, a recent report from the President's Council on Bioethics (see Andrew Lustig, "Immortality," Commonweal, February 13), the authors observe, "a person who attributes his discontent or sadness to sickness may spare himself difficult self-examination and self-recrimination as well as arduous attempts to change the way he lives. He can take mood brighteners without guilt or without any sense that he is missing something. But this benefit, if it is that, may well come at a considerable cost. For one receives sadness as sickness only by emptying it of psychic or spiritual significance." Kierkegaard once remarked that there is "nothing worse than thinking of your own emotions as twaddle," that is, as psychic perturbations devoid of meaning. And yet that is the attitude toward our emotions that many in the medical/priest class adopt today. According to current dogma, anxiety and depression are simply symptoms that impede our ability to function.